Multiple thoracoabdominal injury with incidental obstructive hydrocephalus
Presentation
35 year old male involved in a high speed motor vehicle accident. A CT trauma series was performed.
Patient Data
Colloid cyst at the foramen of Monro with obstructive hydrocephalus.
- Extensive thoracic injuries include multiple rib fractures and sternal fracture, with extensive bilateral pulmonary contusions, left hemothorax and bilateral tiny pneumothoraces associated with extensive mediastinal, chest wall and neck gas.
- Left T7 transverse process fracture.
- Abdominal injuries include peripancreatic and perinephric hematoma with moderate volume of free fluid. Intraperitoneal gas is presumably secondary to laparotomy. Splenectomy.
- Linear hyperdensity inferiorly in the right lobe of liver, suggests an anatomical variation over a laceration.
Case Discussion
This patient has gross thoraco-abdominal multitrauma. In the chest, note the gross loculated hypodensities (-1000HU), consistent with subcutaenous emphysema. This can also be noted on the supine axial films, where the tiny locules of hypodense air have risen to the anterior peritoneum. Small hyperdense stables located anteriorly and in the midline represent staples post closure of the laparotomy wound.
The multiple rib fractures can be seen in bilateral anterior first ribs, where there are extensive, comminuted fractures with minimal displacement. There are also lower mildly displaced anterior rib fractures. These can be best visualized on the lung windows in these sets of images.
Hyperdense contusion can be visualized bilaterally, greater in the left hemithorax than the right. Note the air bronchograms which contain hypodense air contrasting against the hyperdense contusion. This differentiates it from a hemothorax, where the bronchioles and blood vessels would not be seen traversing the lung parenchyma. Small, bilateral, basal pneumothoraces are best noted on the coronal images.
This patient was noted to have an incidental colloid cyst. Colloid cysts are benign intracranial lesions that account for 0.5-1% of brain tumors1. Given their slow growing nature, they usually present with headaches and generalized neurological symptoms. In this patient, however, there is considerable hydrocephalus as noted by the enlargement of the temporal horns and bowing of the third ventricle. Management for this particular case would be either with open or endosurgical removal of cyst.
Case contributed by A/Prof. Pramit Phal.